• Korean Journal of Radiology
• /
• 제23권8호
• /
• pp.828-834
• /
• 2022

Objective: This study aimed to assess the outcomes of outpatient day-care management of unruptured intracranial aneurysm (UIA), and to present the risks associated with different management strategies by comparing the outcomes and adverse events between outpatient day-care management and management with longer admission periods. Materials and Methods: This retrospective cohort study used prospectively registered data and was approved by a local institutional review board. We enrolled 956 UIAs from 811 consecutive patients (mean age ± standard deviation, 57 ± 10.7 years; male:female = 247:564) from 2017 to 2020. We compared the outcomes after embolization among the different admission-length groups (1, 2, and ≥ 3 days). The outcomes included pre- and post-modified Rankin Scale (mRS) scores and rates of adverse events, cure, recurrence, and reprocedure. Events were defined as any cerebrovascular problems, including minor and major stroke, death, or hemorrhage. Results: The mean admission period was 2 days, and 175 patients (191 aneurysms), 551 patients (664 aneurysms), and 85 patients (101 aneurysms) were discharged on the day of the procedure, day 2, and day 3 or later, respectively. During the mean 17-month follow-up period (range 6-53 months; 2757 patient years), no change in post-mRS was observed compared to pre-mRS in 99.6% of patients. Cure was achieved in 95.6% patients; minimal recurrence that did not require re-procedure occurred in 3.5% patients, and re-procedure was required in 2.3% (22 of 956) patients due to progressive enlargement of the recurrent sac during follow up (mean 17 months, range, 6-53 months). There were eight adverse events (0.8%), including five cerebrovascular (two major stroke, two minor strokes and one transient ischemic stroke), and three non-cerebrovascular events. Statistical comparison between groups with different admission lengths (1, 2, and ≥ 3 days) revealed no difference in the outcomes. Conclusion: This study revealed no difference in outcomes and adverse events according to the admission period, and suggested that UIA could be managed by outpatient day-care embolization.

• Korean Journal of Radiology
• /
• 제2권4호
• /
• pp.216-221
• /
• 2001

Objective: To compare, in terms of their demonstration of tears of the anterior glenoid labrum, oblique axial MR arthrography obtained with the patient's shoulder in the abduction and external rotation (ABER) position, with conventional axial MR arthrography obtained with the patient's arm in the neutral position. Materials and Methods: MR arthrography of the shoulder, including additional oblique axial sequences with the patient in the ABER position, was performed in 30 patients with a clinical history of recurrent anterior shoulder dislocation. The degree of anterior glenoid labral tear or defect was evaluated in both the conventional axial and the ABER position by two radiologists. Decisions were reached by consensus, and a three-point scale was used: grade 1=normal; grade 2=probable tear, diagnosed when subtle increased signal intensity in the labrum was apparent; grade 3=definite tear/defect, when a contrast material-filled gap between the labrum and the glenoid rim or deficient labrum was present. The scores for each imaging sequence were averaged and to compare conventional axial and ABER position scans, Student's t test was performed. Results: In 21 (70%) of 30 patients, the same degree of anterior instability was revealed by both imaging sequences. Eight (27%) had a lower grade in the axial position than in the ABER position, while one (3%) had a higher grade in the axial position. Three whose axial scan was grade 1 showed only equivocal evidence of tearing, but their ABER-position scan, in which a contrast material-filled gap between the labrum and the glenoid rim was present, was grade 3. The average grade was 2.5 (SD=0.73) for axial scans and 2.8 (SD=0.46) for the ABER position. The difference between axial and ABER-position scans was statistically significant (p<0.05). Conclusion: MR arthrography with the patient's shoulder in the ABER position is more efficient than conventional axial scanning in revealing the degree of tear or defect of the anterior glenoid labrum. When equivocal features are seen at conventional axial MR arthrography, oblique axial imaging in the ABER position is helpful.

• Korean Journal of Radiology
• /
• 제21권10호
• /
• pp.1187-1195
• /
• 2020

Objective: This study aimed to determine the sonographic features suggestive of extrathyroidal extension (ETE) of thyroid cancers. Materials and Methods: We retrospectively reviewed the sonographic images of 1656 consecutive patients who had undergone thyroidectomy in 2017. The diagnostic performance of sonographic features suggestive of ETE was evaluated using operation and histopathologic reports. Sonographic features for gross ETE to the strap muscle and minor ETE were assessed for thyroid cancer abutting the anterolateral thyroid capsule. Sonographic features for tracheal invasion were assessed according to whether the angle between the tumor and the trachea was an acute, right, or obtuse angle. Sonographic features for recurrent laryngeal nerve (RLN) invasion were assessed based on the association between the tumor and tracheoesophageal groove (TEG) as preserved normal tissue, abutting or protruding into the TEG. Results: ETE was observed in 783 patients (47.3%), including 123 patients with gross ETE (7.4% [strap muscle, n = 97; RLN, n = 24; and trachea, n = 14]) and 660 patients with minor ETE (39.9%). Regarding the diagnosis of gross and minor ETE to the strap muscle, sonographic features of replacement of the strap muscle and capsular disruption showed the highest positive predictive value (75.9% and 58.5%, respectively). Thyroid cancer forming an obtuse angle with the trachea had the highest sensitivity for the diagnosis of tracheal invasion (85.7%), and thyroid cancer protrusion into the TEG showed the highest sensitivity for the diagnosis of RLN (83.3%). Conclusion: Sonography is considered beneficial in the diagnosis of ETE to the strap muscle, trachea, and RLN. Assessment of ETE is important for the accurate staging of thyroid cancer, which in turn determines the extent of surgery or whether active surveillance is appropriate or not.

• 대한영상의학회지
• /
• 제84권5호
• /
• pp.1158-1162
• /
• 2023

오트너 증후군은 중증 심혈관질환에 의해 대동맥궁과 폐동맥 사이에 왼쪽 되돌이후두신경이 압박되면서 마비가 발생하는 질환으로 쉰 목소리가 특징적 증상이다. 조절되지 않는 갑상선중독증은 폐동맥 고혈압을 유발할 수 있는데, 이때 확장된 폐동맥에 의하여 대동맥궁과 폐동맥 사이를 주행하는 왼쪽 되돌이후두신경이 물리적 영향을 받게 될 수 있다. 이로 인해 발생한 쉰 목소리는 갑상선중독증의 적절한 치료를 통해 완전히 회복될 수 있지만, 초기에 원인에 대한 이해가 없어 진단이 늦어질 경우 적절한 치료 시기를 놓치거나 불필요한 수술적 치료의 위험이 있어 영상의학적 판단이 중요하다. 이에 갑상선 중독증을 보인 청소년에서 발생한 오트너 증후군이 갑상선 중독증에 대한 약물 치료 후 호전된 증례를 보고하고자 한다.

• 대한영상의학회지
• /
• 제84권3호
• /
• pp.606-614
• /
• 2023

목적 자궁체부암 출혈에 대한 경카테터 동맥 색전술의 효과와 안전성을 평가하였다. 대상과 방법 20년 동안 자궁체부암 출혈로 경카테터 동맥 색전술(transcatheter arterial embolization; 이하 TAE)을 시행 받은 여섯 명의 환자들의 자료를 후향적으로 수집하였다. 혈관조영술 및 단면 영상 소견, TAE의 세부사항과 임상 경과를 탐구하였으며, TAE의 기술적, 임상적 성공률(technical and clinical success rate)을 각각 계산하였다. 결과 환자군은 자궁내막양 선암종, 육종, 그리고 임신융모종양으로 이루어졌으며, 대부분이 말기 암 환자들이었다. 출혈은 네 명의 환자에서 질출혈로 나타났다. 여섯 명의 환자들에서 일곱 번의 TAE가 시행되었고, 모든 TAE 시술에서 기술적 성공이 달성되었다. 자궁절제술을 받은 두 명의 환자들에서는 골반강 내 재발한 종양의 출혈이 혈변으로 나타났고, 이 환자들에서도 TAE는 기술적 성공을 보였다. 임상적 성공률은 50%로 절반의 환자에서 일주일 이상 출혈 조절이 되었다. 재출혈은 한 명의 환자에서 사망과 직접적으로 연관되었다. 한 명의 환자에서 시술 다음 날 경미한 부작용이 있었다. 결론 TAE는 자궁체부암 출혈에 대한 효과적이고 안전한 방법이며 특히 진행암, 말기암 환자들의 질병 경과 중의 위험한 시기에서 고려될 수 있다.

• 한국간담췌외과학회지
• /
• 제26권1호
• /
• pp.104-112
• /
• 2022

Backgrounds/Aims: In moderate and high-surgical risk patients with acute cholecystitis, studies comparing percutaneous cholecystostomy (PC) vs. endoscopic transpapillary gallbladder stenting (ETGS) vs. endoscopic ultrasound-guided transmural gallbladder stenting (EUGS) are limited. Thus, the aim of this study was to compare efficacy and recurrence of cholecystitis after PC, ETGS, or EUGS during follow-up. Methods: We reviewed 143 moderate and high-surgical risk patients with acute cholecystitis with or without concomitant common bile duct stones who underwent PC, ETGS, or EUGS at our hospital. Technical success rate (TSR), clinical success rate (CSR), and recurrence were compared. Results: TSR in PC or EUGS group was higher than that in the ETGS group for those with concomitant common bile duct stones (100% vs. 100% vs. 73.2%; p = 0.07) and for those without concomitant common bile duct stones (100% vs. 100% vs. 77.3%; p < 0.001). CSR in ETGS or EUGS group was higher than that in the PC group for those with concomitant common bile duct stones (96.2% vs. 100% vs. 87.5%; p = 0.41) and for those without concomitant common bile duct stones (94.1% vs. 100% vs. 63.0%; p = 0.006). Using Kaplan-Meier analysis, the overall recurrent risk was the highest in the PC group (p = 0.004). Conclusions: In moderate and high-surgical risk patients with acute cholecystitis, EUGS provides significantly higher CSR with comparable TSR to PC. Thus, ETGS should be the first choice in those with concomitant common bile duct stones. Among the three patient groups, those who received PC had the highest rate of recurrence.

• Clinical Endoscopy
• /
• 제57권4호
• /
• pp.515-526
• /
• 2024

Background/Aims: The optimal length of the uncovered portion of partially covered self-expandable metal stents (PCSEMSs) used in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) remains unclear. This study investigated the safety and efficacy of PCSEMSs with different uncovered lengths, with a focus on stent migration and time to recurrent biliary obstruction (RBO). Methods: Outcomes of patients undergoing EUS-HGS using PCSEMSs with 5-mm and 20-mm uncovered portions at our institution from January 2016 to December 2021 were compared. Results: Sixty-two patients underwent EUS-HGS using PCSEMS (5/20-mm uncovered portions: 32/30). Stent migration occurred only in the 5-mm group. There were no differences in RBO rates (28.1% vs. 40.0%) or median time to RBO (6.8 vs. 7.1 months) between the two groups. Median overall survival (OS) was longer in the 20-mm group (3.1 vs. 4.9 months, p=0.037) due to the higher number of patients that resumed chemotherapy after EUS-HGS (56.7% vs. 28.1%, p=0.029). Good performance status, absence of hepatic metastases, and chemotherapy after EUS-HGS were independent predictors of longer OS. Conclusions: No migration was observed in patients treated with PCSEMS with 20-mm uncovered portions. Patients treated with PCSEMS with 20-mm uncovered portions performed at least as well as those treated with 5-mm uncovered portions in all material respects.

• 대한유전성대사질환학회지
• /
• 제24권1호
• /
• pp.1-9
• /
• 2024

MELAS 증후군은 다양한 임상 증상을 나타내는 복잡하고 다면적인 미토콘드리아 질환으로, 반복적인 뇌졸중 유사 에피소드, 발작, 당뇨병, 심근병증 등을 포함한다. 이러한 증상들은 뇌, 심장, 근육과 같은 대사적으로 활발한 조직에 미토콘드리아 기능 장애가 미치는 심각한 영향을 반영한다. 현재의 치료는 이러한 증상을 완화하고 미토콘드리아 기능을 개선하는 데 중점을 두고 있으며, 증상 치료, 고용량 비타민 요법 및 고용량 타우린 보충과 같은 혁신적인 접근 방식을 포함한다. 유전자 치료 및 미토콘드리아 표적 약물 분야의 새로운 치료법은 근본적인 유전자 돌연변이를 해결하고 미토콘드리아 건강을 향상시킬 수 있는 유망한 새로운 길을 제공한다. MELAS에 대한 이해가 계속 깊어짐에 따라, 유전자 검사 및 치료적 개입의 발전은 환자의 결과를 크게 개선할 가능성을 갖고 있다. MELAS 치료의 미래는 낙관적이며, 진행 중인 연구는 더 효과적이고 표적화된 치료법을 위한 길을 열어 이 질환의 부담을 줄이고 영향을 받는 개인들의 삶의 질을 향상시키는 것을 목표로 하고 있다.

• 한방안이비인후피부과학회지
• /
• 제37권3호
• /
• pp.17-28
• /
• 2024

Objectives : The aim of this study is to explore the potential of oriental medicine in managing rosacea through the regulation of the autonomic nervous system. Methods : We reviewed studies on the pathophysiology and medical treatment (both western and oriental medicine) of rosacea, as well as the relationship between rosacea and the autonomic nervous system, using four databases: PubMed, OASIS, RISS, and NDSL. Results : Rosacea is a chronic recurrent inflammatory disease characterized by symptoms such as facial flushing, inflammatory papules, and pustules. In Western medicine, symptomatic treatments like vasoconstrictors, doxycycline, and anti-inflammatory drugs are primarily used. According to the pathophysiological mechanisms of rosacea, the autonomic nervous system is closely related, particularly with sympathetic overactivity causing vasodilation and local inflammation in rosacea patients. Additionally, recent studies report that rosacea patients frequently exhibit neuropsychiatric symptoms such as anxiety, depression, and insomnia, which are closely linked to autonomic dysfunction and contribute to the worsening of skin symptoms. However, current studies on the use of oriental medicine for rosacea focus mainly on anti-inflammatory effects at the local level, similar to conventional treatments. Conclusions : Based on the close involvement of the autonomic nervous system in the pathophysiological mechanisms of rosacea and numerous studies showing that oriental medicine can effectively regulate autonomic function, applying such treatments to rosacea patients may improve not only skin symptoms but also the frequently associated neuropsychiatric symptoms like anxiety, depression and insomnia.

• Journal of Cerebrovascular and Endovascular Neurosurgery
• /
• 제26권2호
• /
• pp.152-162
• /
• 2024

Objective: Stroke is the second-leading cause of death globally. Intracranial atherosclerotic stenosis (ICAS) represents 10-15% of ischemic strokes in Western countries and up to 47% in Asian countries. Patients with ICAS have an especially high risk of stroke recurrence. The aim of this meta-analysis is to reassess recurrent stroke, transient ischemic attack (TIA), and other outcomes with stenting versus best medical management for symptomatic ICAS. Methods: The search protocol was developed a priori according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The OVID Medline, Embase, Web of Science, and Cochrane Library databases were searched from inception to August 14th, 2022. Results: This meta-analysis included four randomized controlled trials (RCTs), with a total number of 991 patients. The mean age of participants was 57 years. The total number of intracranial stenting patients was 495, and the number of medical treatment patients was 496. The included studies were published between 2011 and 2022. Two studies were conducted in the USA, and the other two in China. All included studies compared intracranial stenting to medical treatment for ICAS. Conclusions: In patients with ischemic stroke due to symptomatic severe intracranial atherosclerosis, the rate of 30-day ischemic stroke, 30-day intracerebral hemorrhage, one-year stroke in territory or mortality favored the medical treatment alone without intracranial stenting. The risk of same-territory stroke at last follow-up, disabling stroke at last follow-up, and mortality did not significantly favor either group. Intracranial stenting for atherosclerosis did not result in significant benefit over medical treatment.